Bieber Posted October 22, 2012 Posted October 22, 2012 You are working on a dual paramedic truck when you are dispatched to a patient complaining of anxiety. You are about 15 miles out from the nearest hospital in a suburban/semi-rural part of your response area. When you arrive on scene you are led inside a large, newer house to the living room where you find your patient, an approximately 35 year old man sitting on the couch appearing to be in moderate distress. Go.
cscboulder11 Posted October 22, 2012 Posted October 22, 2012 Who called 911? If someone else did, are they present? How long ago did he/they call 911? Any distress before that? Pain level? Ability to breathe? Breath sounds? Any allergies? Specifically, food ones? Is he hot/cold? Pale, sweaty, clammy? Is he in shape? Any clues that you can see?
Bieber Posted October 22, 2012 Author Posted October 22, 2012 Who called 911? If someone else did, are they present? Family called for the patient. How long ago did he/they call 911? Any distress before that? About thirty seconds before you were dispatched. They've been feeling shitty for the last fifteen minutes. Pain level? 10/10. Ability to breathe? Breath sounds? Patient reports shortness of breath, lung sounds are clear bilaterally. Any allergies? Specifically, food ones? Penicillin. Is he hot/cold? Pale, sweaty, clammy? A little cool, pale, clammy. Is he in shape? Looks to be on the thin side. 140lbs, 5'10". Any clues that you can see? Nothing that stands out.
Mateo_1387 Posted October 22, 2012 Posted October 22, 2012 I ask this with the utmost seriousness. How does the wife look? Describe her and her interaction with the hubby... Ok, maybe not the utmost seriousness, but I still ask it as a valid question. Otherwise, Vitals with temp EKG Medical history Medicines
Bieber Posted October 22, 2012 Author Posted October 22, 2012 (edited) I ask this with the utmost seriousness. How does the wife look? Describe her and her interaction with the hubby... Ok, maybe not the utmost seriousness, but I still ask it as a valid question. Otherwise, Haha... wife looks normal. Not an obvious druggie or alcoholic, looks genuinely concerned, all of that good stuff. These folks are obviously upper middle-class. Vitals with temp HR: 280 BP: 138/88 RR: 20 non-labored BGL: 78 Temp: 98.5 EKG Medical history ADHD, anxiety. Medicines Xanax, Adderall. Edited October 22, 2012 by Bieber
Mateo_1387 Posted October 22, 2012 Posted October 22, 2012 (edited) Sweet ! Damn fast. 12 lead? When has he taken his medicines, how many? Any drug use? What was he doing at the onset of symptoms? Surprise butt sex? Are you sure about that wife? Any similar symptoms (maybe less severity) in recent days? Recent illness? Any recent symptoms he may have though as innocuous? Edited October 22, 2012 by Mateo_1387
Curiosity Posted October 22, 2012 Posted October 22, 2012 No hx of SVT? Has this ever happened before? If so, how was it relieved? 10/10 pain where, describe pain, did pain start suddenly, did it start at the same time he started feeling his anxiety? Do his anxiety attacks usually present this way, how does he relieve them when they occure? Any drug use, alcohol? What were they doing when it started? Any signs if dehydration? If no to drugs or physical activity or dehydration: O2 if indicated (what are his sats?), vagal, adenosine 6mg, 12mg.
Bieber Posted October 22, 2012 Author Posted October 22, 2012 pain level 10/10.........where? PQRST? In her chest. P - No worsening on palpation, hasn't moved from her seat since it started. Q - Like an elephant is sitting on her chest and a swarm of bees is flying around inside as well. R - None. S - 10/10 T - Constant and worsening for the last fifteen minutes. 12 lead? Shows a narrow complex tachycardia rate of 180 with normal axis deviation and no ST-elevation/depression, T-wave inversion or other conduction abnormalities. When has he taken his medicines, how many? Took his Xanax about an hour ago, usual dose. Any drug use? None! Surprise butt sex? None... so far! Are you sure about that wife? Pretty sure. =) What was he doing at the onset of symptoms? Watching TV. Any similar symptoms (maybe less severity) in recent days? No attacks for about the last week or so, but he states that his panic attacks have been getting worse over the last 3-4 months. Recent illness? Nada. Any recent symptoms he may have though as innocuous? Worsened panic attacks over the last few months, but none as bad as today. The wife insisted on calling today because she noticed a vessel in his neck "pounding". No hx of SVT? Nope! Has this ever happened before? If so, how was it relieved? Yes. Relieved with time. 10/10 pain where, describe pain, did pain start suddenly, did it start at the same time he started feeling his anxiety? Chest, yes, yes. Do his anxiety attacks usually present this way, how does he relieve them when they occure? Yes but not as severe though worsening over the last few months. Any drug use, alcohol? What were they doing when it started? Any signs if dehydration? Mucous membranes are pretty dry. No alcohol. Sitting watching TV. If no to drugs or physical activity or dehydration: O2 if indicated (what are his sats?), vagal, adenosine 6mg, 12mg. SpO2 is 98% on room air. What do you guys wanna do? What are we thinking so far?
Curiosity Posted October 22, 2012 Posted October 22, 2012 250ml fluid challenge see if there's any change. One post you said hr of 280, an other 180, and you keep switching between a him and a her, is it a transsexual who's having an anxiety attack because there are strangers around?
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